Remote by default general practice: must we, should we, dare we?

Greenhalgh, Trisha; Rosen, Rebecca

doi:10.3399/bjgp21x715313

Cited by 37 publications

(40 citation statements)

References 17 publications

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“…Primary care clinicians welcomed the infection control benefits, empty waiting rooms, and slackening of red tape that accompanied the initial shift to remote (5). But they also warned of an uncomfortable "brave new world" characterized by fewer consultations overall, loss of continuity of care, threats to the clinician-patient relationship, inequalities of access, and clinical risks (6)(7)(8)(9). Lay media coverage of remote consultations mirrored this pattern, with an initial positive response followed by stories of inaccessibility, missed diagnoses and patients feeling "fobbed off " with phone calls (10,11).…”

mentioning

confidence: 99%

Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics

Greenhalgh

Rosen

Shaw

et al. 2021

Front. Digit. Health

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105

112

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Establishing and running remote consultation services is challenging politically (interest groups may gain or lose), organizationally (remote consulting requires implementation work and new roles and workflows), economically (costs and benefits are unevenly distributed across the system), technically (excellent care needs dependable links and high-quality audio and images), relationally (interpersonal interactions are altered), and clinically (patients are unique, some examinations require contact, and clinicians have deeply-held habits, dispositions and norms). Many of these challenges have an under-examined ethical dimension. In this paper, we present a novel framework, Planning and Evaluating Remote Consultation Services (PERCS), built from a literature review and ongoing research. PERCS has 7 domains—the reason for consulting, the patient, the clinical relationship, the home and family, technologies, staff, the healthcare organization, and the wider system—and considers how these domains interact and evolve over time as a complex system. It focuses attention on the organization's digital maturity and digital inclusion efforts. We have found that both during and beyond the pandemic, policymakers envisaged an efficient, safe and accessible remote consultation service delivered through state-of-the art digital technologies and implemented via rational allocation criteria and quality standards. In contrast, our empirical data reveal that strategic decisions about establishing remote consultation services, allocation decisions for appointment type (phone, video, e-, face-to-face), and clinical decisions when consulting remotely are fraught with contradictions and tensions—for example, between demand management and patient choice—leading to both large- and small-scale ethical dilemmas for managers, support staff, and clinicians. These dilemmas cannot be resolved by standard operating procedures or algorithms. Rather, they must be managed by attending to here-and-now practicalities and emergent narratives, drawing on guiding principles applied with contextual judgement. We complement the PERCS framework with a set of principles for informing its application in practice, including education of professionals and patients.

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mentioning

confidence: 99%

Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics

Greenhalgh

Rosen

Shaw

et al. 2021

Front. Digit. Health

Self Cite

105

112

View full text Add to dashboard Cite

show abstract

“…A range of factors were identified by Greenhalgh et al in use of remote consultation in primary care. 8 These include but are not limited to patient group factors, the reason for consulting, the clinical relationship with the patient and practice ethos. 8 It was interesting to note that most PAs were happy to manage the mental health scenario remotely, regardless of their experience level.…”

Section: Julie Hoskin and Ria Agarwalmentioning

confidence: 99%

Remote consultations for physician associates in primary care: qualitative feedback from a regional cohort study

Hoskin¹,

Agarwal

2021

Future Healthcare Journal

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The advent of the COVID-19 pandemic necessitated a dramatic shift in the traditional general practice (GP) model of consultation. General practice was forced to deliver care remotely and this workforce included physician associates (PAs), who may not have been previously exposed to remote consultations prior to the pandemic. A qualitative online questionnaire explored how a cohort of primary care PAs in Sheffield adapted to the use of remote consultations, how clinically safe they felt in utilising this method, supervision arrangements in their practices and how they would manage three clinical scenarios. Recommendations are limited by the small sample size, but based upon this feedback we recommend inclusion of remote consultation as part of the student experience in higher educational institutions (HEIs) that do not currently utilise it; discussion of the PAs' previous experience of remote consultation at their induction in order to decide how to most effectively use their skillset while they transition into remote consultations, appreciating that they may have a lower threshold to invite patients in for a face-to-face appointment if newly qualified; on-demand supervision for remote consultations where possible; and reinforcement of clinical and pastoral review from the employer to manage the increasing scope of the PA.

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“…12 Early evaluation of "remote by default" care finds over-protocolised general practice can come with risk. 13 Case based judgment is needed to decide if remote consultation is best for a particular patient at a particular time. Complexity in primary care consultations include, for example, "doorknob disclosures," when patients mention something crucial as they are leaving, and early detection of cancer through clinical intuition and timely investigation.…”

Section: Remote Care and The Future Of Quiet Listeningmentioning

confidence: 99%

“…We cannot assume remote care is the best option for most patients in the long term 12. Early evaluation of “remote by default” care finds over-protocolised general practice can come with risk 13. Case based judgment is needed to decide if remote consultation is best for a particular patient at a particular time.…”

Section: Remote Care and The Future Of Quiet Listeningmentioning

confidence: 99%

See 1 more Smart Citation

Covid-19 makes it harder for GPs to offer the quiet listening that made all the difference to me

2021

BMJ

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Remote by default general practice: must we, should we, dare we?

Cited by 37 publications

References 17 publications

Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics

Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics

Remote consultations for physician associates in primary care: qualitative feedback from a regional cohort study

Covid-19 makes it harder for GPs to offer the quiet listening that made all the difference to me

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